Prevent bicycle injuries in your ED

Focus on risk of minor injuries when explaining to children the necessity of wearing a helmet

Springtime brings an increasing number of children with bicycle injuries to the ED. Nurses should take the lead in preventing those tragedies, says Dorraine Day Watts, PhD, RN, CEN, trauma researcher at Inova Regional Trauma Center in Falls Church, VA "Nurses are the best advocates for injury prevention," she stresses. "Patients consider you an approachable expert, and you have more interaction with other parents in the community."

Provide prevention information to as many parents and children as possible, urges Barbara A. Foley, RN, BS, associate executive director of EN CARE, based in Arlington, VA. "It's extremely important for us to give instructions not only when a child comes in with a bicycle injury, but also when a seven year old comes in with a sore throat and tells you they got a bike for their birthday," she says.

According to the National Highway Traffic Safety Administration (NHTSA), the national usage rate for helmets is only 18%, Foley says. "Wearing a bike helmet is the single most effective countermeasure to reduce head injuries and fatalities," she notes. Here are some tips to reduce the number of bike injuries in your ED:

Learn why children do not wear bicycle helmets. For older children, peer pressure is the number one reason for non-helmet use, says Susan Laurence, RN, injury prevention coordinator at Children's Hospital Medical Center in Cincinnati, OH. "Even if an older child suffers an injury, that doesn't mean they will start wearing a helmet," she notes. "Older kids may put it on when they leave but take it off when they get around the block."

Persistence is key, she stresses. "You have to keep trying, sometimes an older child can convince the other kids in their neighborhood," she says.

Peer pressure isn't as big a factor with younger children. "Younger kids are riding closer to home, so their parents can keep an eye on them, and parents have more influence on them," she notes. "When children from kindergarten through third grade were asked why they didn't wear their helmets, they usually responded they felt they were good bicycle riders so didn't need them, or they can't find them when they're going to ride their bikes. With older kids, it was a peer pressure issue."

Focus on the risk of minor injuries. Instead of focusing on the risk of a fatality, it's often more effective to warn children about more common injuries. "Kids don't have a big concept of death. It's an abstract concept," says Laurence. "It can be more effective to explain to them that even a minor injury might be facially disfiguring or result in a lifetime of disability."

The same strategy can work with parents. "People think of death as a remote possibility. Parents don't put helmets on their children for the same reason people don't wear their seatbelts," she says. "On the other hand, if you tell a parent, `If your little girl falls off her bicycle she could wind up with a facial laceration or require special education,' it can have a major impact. There are a lot of parents out there who don't realize what the long-term impact of even a minor head injury can be."

ED nurses are in a position to speak from experience, Foley emphasizes. "We see the consequences of what happens when you don't wear a helmet, and it's extremely important to tell the truth about the injuries that can occur," she says.

Hold focus groups. At Cincinnati Children's Hospital, several focus groups were held with local seventh and eighth grade teenagers. "The big thing we heard over and over again was the peer element-helmets aren't cool, and they aren't attractive to the opposite sex," says Laurence.

A separate focus group was held to get input from parents in the community. "The reasons that teenagers and their parents give for not wearing helmets might be two different things," Laurence explains. "We wanted to look at what they thought could happen to convince their kids to wear helmets."

Make helmets available to the community. At Children's Hospital, more than 54,000 helmets were sold to parents and children in the community. "Along with the helmet, parents receive a brochure which explains how to choose a helmet which fits properly," says Laurence. The hospital has partnered with elementary schools and local fire, police, and EMS to maximize educational efforts.

Buying in bulk greatly reduces the cost, so that helmets can be offered at a nominal charge. "When you buy 54,000 helmets you get a bit of a price break," notes Laurence. "This is a way to allow lower income and underserved communities to buy helmets."

Target high-risk populations. Although prevention efforts should include all bicycle riders, certain age groups are at higher risk. "The fatality rate of bicyclists between the ages of 5 and 15 is nearly double the rate of all others who ride bikes, so we need to focus on those years,"notes Foley.

Include parents in prevention efforts. "Often, children will be riding with their parents with helmets on, yet the parent isn't wearing a helmet," says Foley. "They act as role models, so it's real important to talk to them too and encourage them to wear helmets, because kids learn by seeing."

Instruct children on how to wear helmets. Children need to be taught how to wear their helmet, Foley emphasizes. "You can't just put a helmet on their head-it has to be worn correctly, which means a snug fit, appropriate use of straps, sitting evenly between their ears and low on the forehead," she says. "If the helmet is worn toward the back of head and the child falls forward, it won't protect them."

Inform parents and children about local laws. Helmet use laws in conjunction with education are most effective, says Foley. Fifteen states have enacted age-specific bicycle helmet laws, with most of the laws covering bicyclists under 16 years of age.